| The role of diastolic blood pressure when treating isolated systolic hypertension. | |
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MedLine Citation:
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PMID: 10510985 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess the role of treated diastolic blood pressure (DBP) level in stroke, coronary heart disease (CHD), and cardiovascular disease (CVD) in patients with isolated systolic hypertension (ISH). DESIGN: An analysis of the 4736 participants in the Systolic Hypertension in the Elderly Program (SHEP) was undertaken. The SHEP was a randomized multicenter double-blind outpatient clinical trial of the impact of treating ISH in men and women aged 60 years and older. MAIN OUTCOME MEASURES: Cox proportional hazards regression analysis, with DBP and systolic blood pressure (SBP) as time-dependent covariables. RESULTS: After adjustment for the baseline risk factors of race (black vs other), sex, use of antihypertensive medication before the study, a composite variable (diabetes, previous heart attack, or stroke), age, and smoking history (ever vs never) and adjustment for the SBP as a time-dependent variable, we found, for the active treatment group only, that a decrease of 5 mm Hg in DBP increased the risk for stroke (relative risk, [RR], 1.14; 95% confidence interval [CI], 1.05-1.22), for CHD (RR, 1.08; 95% CI, 1.00-1.16), and for CVD (RR, 1.11; 95% CI, 1.05-1.16). CONCLUSIONS: Some patients with ISH may be treated to a level that uncovers subclinical disease, and some may be overtreated. Further studies need to determine whether excessively low DBP can be prevented by more careful titration of antihypertensive therapy while maintaining SBP control. It is reassuring that patients receiving treatment for ISH never perform worse than patients receiving placebo in terms of CVD events. |
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Authors:
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G W Somes; M Pahor; R I Shorr; W C Cushman; W B Applegate |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Archives of internal medicine Volume: 159 ISSN: 0003-9926 ISO Abbreviation: Arch. Intern. Med. Publication Date: 1999 Sep |
Date Detail:
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Created Date: 1999-10-19 Completed Date: 1999-10-19 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 2004-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Preventive Medicine, University of Tennessee, Memphis 38105, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Ambulatory Care Antihypertensive Agents / therapeutic use* Blood Pressure* / drug effects Cerebrovascular Disorders / etiology*, physiopathology Coronary Disease / etiology*, physiopathology Diastole Double-Blind Method Female Humans Hypertension / complications, drug therapy, physiopathology* Male Middle Aged Multicenter Studies as Topic Randomized Controlled Trials as Topic Risk Systole |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents |
| Comments/Corrections | |
Comment In:
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Arch Intern Med. 2000 May 8;160(9):1378
[PMID:
10809051
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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